The use of mainstream maternity services by urban Aboriginal women is an important issue for health professionals. Aboriginal mothers are much more likely to die in childbirth than are non-Aboriginal mothers and their excessive risk does not appear to have changed over the last two decades. The infant mortality rate is three times higher than for non-Aboriginal infants. Therefore, this project aimed to discover the cultural needs of urban Aboriginal women who use mainstream maternity services. Six Aboriginal women who were attending the ante-natal clinic at Daruk Aboriginal Medical Service were interviewed. The thesis included the following recommendations and strategies for their implementation: 1/. Establishment of a discrete Aboriginal women's health unit in Western Sydney. 2/. Provision of culturally acceptable education about pregnancy and childbirth. 3/. Promotion of breastfeeding. 4/. Education and encouragement for non- Aboriginal health professionals. / Master of Nursing (Hons)

In this study, the childbearing women's perception of the role of a midwife in Australia was explored using a descriptive study. Data was gathered using a semi structured questionnaire.The findings revealed that childbearing women in Australia overwhelmingly believed a midwife is specifically trained and qualified to deliver babies normally and to care for a woman in labour.In addition, the belief was that a midwife is trained to provide a comprehensive range of maternity related tasks.The overriding themes which emerged identified the midwife as a source of advice, information, support, education, guidance, specific midwifery knowledge and being a liason person between the doctor and the pregnant woman.Limitation of the role of a midwife was believed to be due to the nursing based training of a midwife.The findings from this study revealed that childbearing women in Australia, United Kingdom and Singapore have similar perceptions of a midwife's role.Recommendations were made for further studies to investigate the reasons for a persistent lack of information regarding the role of a midwife and the type of information required by pregnant women. / Master of Nursing (Hons.)

Includes list of papers arising from this thesis. "July 2004" Includes bibliographical references (leaves 253-297)

The following thesis seeks to inquire whether the recent phenomenon of women seeking out and indeed actively engaging with a medicalised birth stems from a shift in not only perceptions of risk, but also how a shift in responsibility, choice and control has impacted on the birthing women of Australian society. The thesis examines sociology of risk employing the work of both Beck and Giddens, although an emphasis will be placed on the work of Ulrich Beck. The three major themes that underpin the work of Beck, namely his risk society thesis, reflexive modernization and individualization are employed to explore some of the issues that concern the relationship between risk and society, the ramifications of this form of society on its inhabitants and specifically in relation to its impact on those experiencing pregnancy and childbirth. The Risk Society as an explanatory framework was empirically tested by conducting 45 interviews with women who had recently given birth from three separate birthing environments: private birth mothers, birth centre and home birth mothers. The argument is put forward that whilst previous research into the area of childbirth is clearly important in shedding a critical light upon childbirth practices, it does nevertheless neglect some important current social changes. In this respect, the application of Beck and Giddens work to the area of sociology of reproduction captures more adequately the ideological shift which this thesis examines. It is argued, through the scrutinizing gaze of the public, that the pregnant woman is the least able to escape the consequences of risk society where changed notions of health and responsibility have created a cultural acceptance of medical intervention of childbirth. / Doctor of Philosophy (PhD)

During pregnancy the female body must accommodate the enlarging gravid uterus and increased mass. Therefore the maternal musculoskeletal system is required to adapt in both morphology and functional workload. After childbirth there is a rapid change in both mass and dimensions, requiring further adaptations. The objectives of the study were to investigate seated and standing upper body posture, the kinematics of seated and standing trunk motion, and the three dimensional kinematics and kinetics during rising to stand from a chair, as pregnancy progressed and in the early post-birth period. Nine maternal subjects (aged 28 to 40 years) were tested at less than 16 weeks, 24 weeks, 30 weeks, 38 weeks gestation and at 8 weeks postbirth. The subjects, fitted with 37 retroreflective markers, were filmed during upright sitting, quiet standing, and four trials each of maximum seated and standing trunk forward flexion, side to side flexion and during maximum seated axial rotation. Three trials each of constrained and free rising to stand from a height adjustable stool and with each foot placed on a forceplate were also recorded. An eight-camera motion analysis system was used to record movements of the body segments and synchronised force plate variables in three dimensions. Motion of the ankle, knee and hip joints, pelvic, thoracic and head segments and the thoracolumbar and cervicothoracic spines and shoulder joints were investigated. Twelve nulliparous subjects (aged 21 to 35 years) were used as controls to provide standard descriptive data and to investigate the consistency of the selected biomechanical variables with repeated testing. A repeated measures ANOVA was used to investigate the possibility of linear and quadratic trends showing systematic changes within the maternal group, over the four test sessions during pregnancy for each variable. Two tailed Student t-tests were used to compare the maternal postbirth variable results with the control group. There was no significant effect of pregnancy on the upper body posture during upright sitting and quiet standing. Postbirth, the pelvic segment had a smaller anterior orientation and the thoracolumbar spine was less extended, indicating a flatter spinal curve. The maternal subjects were similar to the control subjects in early pregnancy and postbirth for trunk segment motions during seated and standing forward flexion and side to side flexion and seated axial rotation. Strategies, such as increasing the width of the base of support and reducing obstruction to movements from other body parts, were used in late pregnancy in attempts to minimise the effects of increased trunk mass and circumference. For seated and standing side to side flexion, the strategies were successful and no significant decreases in range of motion were seen. For seated and standing forward flexion and seated axial rotation, motion of the thoracic segment and the thoracolumbar spine were significantly reduced, although movement of the pelvis was less affected. In early pregnancy and postbirth the kinematics and kinetics of the lower limbs and upper body segment kinematics during constrained and free rising were generally similar to the control subjects. As pregnancy progressed there were increases in mass and dimensions of body segments. The effect of increased mass was seen in increased ground reaction forces and sagittal plane lower limb joint external moments. An increased base of support width was found in association with an increased lateral ground reaction force and ankle inversion moment from each foot, which would move the body centre of mass medially. There was little change in the three dimensional kinematics of the thoracolumbar and cervicothoracic spine, although the contribution of the upper body segments differed for each rise condition. There were also few significant changes in the displacement of the ankle, knee and hip, and the angular velocity of ankle and knee joints. The maternal subjects were thus able to flex the upper body forward, raise the body and maintain stability as pregnancy progressed, regardless of whether the rise to stand was performed in a natural manner or under constrained conditions. The overall results show that, contrary to expectations as pregnancy progressed, maternal subjects minimised propulsion rather than increasing it to overcome the increased mass and possibly limited trunk flexion. A fear of postural instability may have made the subjects more cautious and as they were able to adequately flex the trunk forward, propulsion was minimised in favour of maintaining upright terminal balance.

Fetal alcohol spectrum disorders (FASD), caused by maternal alcohol consumption during pregnancy, has been extensively studied in the human. Animal studies show that alcohol exposure during very early development may result in severe brain damage, often incompatible with a postnatal life. However, for surviving offspring it is unknown whether they suffer long term brain damage. The final assembly of the mature brain results from a controlled balance between proliferation of glial and neuronal precursors and programmed cell death. The overall aim of the current study was to use a physiologically relevant mouse model to assess the acute and long-term effects of binge alcohol exposure on the early embryo, to simulate human pregnancy at the third week of gestation when pregnancy may be undetected. A number of paradigms were used to assess the acute dose-response effect, the blood alcohol concentration (BAC) profile and the extent of cell death following alcohol exposure on gestational day (G) 7.5. The exposure paradigms were single binge IG6.5, IG4.5, IP4.5, or an extended binge IG4.5+, IG3.0+. Two control groups were Con6.5 and Con4.5+. Acute cell death was determined using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), activated caspase-3 staining, and transmission electron microscopy. Cell proliferation was investigated using S-phase immuno-labeling, bromodeoxyuridine (BrdU) birthdating and immuno-detection (BrdU/anti-BrdU). The long-term effects were investigated at G18.5 and postnatal day (PN) 60. Unbiased stereological methods were used to assess the effect of ethanol exposure at G7.5 on neocortical volume, cell number and density of neurons, glial cells, and capillary cells at PN60. The first principal finding of the present study was that binge ethanol exposure during gastrulation resulted in acute apoptotic cell death in the ectoderm of the mouse embryo. Cell death was dependent on both peak BAC and the duration of elevated BAC. Significant increased cell death (TUNEL labeling) was observed in groups IG6.5 (9.43 � 2.08%) and IG4.5+ (8.97 � 2.12%) compared with control groups Con6.5 (2.14 � 0.09%) and Con4.5+ (2.81 � 0.36%). There was no significant increased cell death in ethanol exposed groups IG4.5 (3.43 � 0.45%), IP4.5 (3.68 � 0.67%), or IG3.0+ (1.72 � 0.24%). TEM analysis revealed that cell death exhibited characteristics of the apoptotic pathway. The second principal finding of the present study was that binge ethanol exposure during gastrulation resulted in acute arrested proliferation in the ectoderm of the mouse embryo. The S-phase proliferation was significantly decreased within the whole ectoderm in the ethanol exposed group IG6.5 (45.58 � 2.34%) compared with control group Con6.5 (62.08 � 3.11%). The third principal finding of the present study was that binge ethanol exposure during gastrulation induced the long term effect of laminate disorganization in the neocortex. The incidence of abnormal lamination was 87.5% in IG6.5 compared with 16.7% in IG3.0+ and 14.3% in Con6.5. Although ethanol exposure increased embryonic reabsorption, decreased litter size, and increased abnormal offspring, neocortical volume, and the total number of neurons, glial cells, and capillary cells was not affected. The total number (10⁶) of neurons, glial cells, and endothelial cells respectively was 12.221 � 0.436, 4.865 � 0.167, and 2.874 � 0.234 in IG6.5; 11.987 � 0.416, 4.942 � 0.133, and 2.922 � 0.130 in IG3.0+; and 11.806 � 0.368, 5.166 � 0.267, and 3.284 � 0.217 in controls, at PN60. These results provide important information pertinent to fetal outcome for those women who drink heavily in early pregnancy. The results also demonstrate the importance of the pattern of ethanol exposure and blood alcohol concentration in determining the magnitude of ethanol�s teratogenic impact. Ethanol exposure on G7.5 that resulted in a high transient BAC, induced disorganized neocortical lamination, indicative of a permanent structural change. This disruption may result in altered neocortical function and requires further investigation.

Gestational diabetes (GDM) is a potentially serious disorder requiring timely diagnosis and management to prevent adverse maternal and fetal outcomes. Of increasing concern today, when treating the woman with GDM, is the need to provide every woman with an intensive management plan to optimise the likelihood of favourable pregnancy outcomes. Early identification of those women with GDM who require insulin therapy in addition to diet therapy would be beneficial in the planning and standardisation of clinical management protocols, to enhance pregnancy outcomes and increase cost benefits with improved allocation of resources. The aim of this study was to evaluate the ability of the fasting plasma glucose level (FPG) at diagnosis to predict an increased risk to the fetus and the need for insulin therapy in a pregnancy complicated by GDM. A prospective longitudinal study design and recruitment by convenience sample was used. Data were obtained from 327 women and their babies. Diagnosis of GDM was made by a 75 gram oral glucose tolerance test (OGTT) using Australasian Diabetes in Pregnancy Society (ADIPS) criteria with the exception of seven women diagnosed on a blood glucose level >11.1mmol/l. Following consent of the women data were collected by a self report questionnaire and the medical record system at three points; at first intervention, following delivery and at the postpartum OGTT. Demographic, social, medical, maternal and neonatal outcome data were collected. The management protocol was similar for all of the women. Following nutritional intervention any woman who could not meet the glycemic targets of <= 5mmol/l fasting and/or <= 6.5mmol/l two hours postprandial was commenced on insulin therapy. The women had a mean age of 32 years, body mass index (BMI) of 25.7 and parity of 2 (range 1-12). Diagnosis was made at an average of 30 weeks and 70 women required insulin therapy with a mean dose of 34 IU per day, commencing at a mean of 31 weeks gestation. Mean birthweight was 3400G. Of the babies 12% were >4000G. Congenital abnormalities occurred in 3%, neonatal morbidities in 2% and there was 1 death in utero. Logistic regression analysis found the following significant associations: Increasing maternal BMI was related to increasing FPG levels at diagnosis and the requirement of higher insulin doses. There was a negative linear relationship to weight gain. Ethnicity was associated with maternal BMI and ethnicity with BMI was associated with birthweight in the specific ethnic group. BMI with insulin therapy as a covariate and the FPG value at OGTT were predictive of persistent glucose intolerance in 14% of women postpartum. Each value of the OGTT was a significant predictor of the need for insulin therapy as a function of the week of gestation. The FPG level was the statistical model of best fit. A 50% probability for requiring insulin was reached with a FPG at diagnosis of 4.0 mmol/l if tested at 10 weeks gestation, 5.1mmol/l at 20 weeks and 6.1 mmol/l at 30 weeks (p<.001). These results support the substantive research aim of the study. The model has the power to predict the probability (risk) of requiring insulin therapy based on the maternal FPG level at the OGTT according to the week of gestation. The study results demonstrate that glucose intolerance is linked to a number of adverse maternal and fetal outcomes in a continuous and graded fashion. The degree of reversibility of maternal and fetal risk through therapeutic interventions such as nutrition therapy, blood glucose monitoring, exercise and active patient participation aimed at improving glucose tolerance is unknown. Therefore, the rationale for, and feasibility of, new treatment strategies such as the application of this statistical model as a management approach require large scale randomised intervention studies, oriented toward measuring maternal and fetal outcomes amongst different populations.

Thesis (Ph. D.)--University of Texas at Austin, 2006. / Vita. Includes bibliographical references.

<p>The tolerance towards the semi-allogenic foetus is obtained through both systemic and local changes in the maternal immune response. Locally, in the decidua, the cell composition differs from that found in the blood; natural killer (NK) cells and macrophages being the major cell types. Decidual macrophages (dMØ), which are alternatively activated, and trophoblasts, placental cells of foetal origin, are believed to participate in the foetal tolerance at the foetal-maternal interface. To test the recruitment ability of macrophages and trophoblasts, and to test if these cells are responsible for the special cell composition in the decidua, a migration assay was established. In this migration assay peripheral blood mononuclear cells (PBMC) were allowed to migrate through Matrigel-coated transwell inserts into lower wells containing a recruiting stimulus. After testing several conditions, a protocol was established for further use. The results showed that <em>in vitro</em> alternatively activated macrophages, which display many of the surface markers as dMØ, hold a recruiting ability and recruit monocytes. Further there was an indication that trophoblasts also hold a recruiting ability. Neither cell types were shown to recruit NK cells. In conclusion, this study presents a suitable protocol for assessing chemotactic factors and different cell type’s ability to recruit cells from blood. Although the experiments need to be repeated and extended and the recruitment ability of dMØ needs to be evaluated in detail before a final conclusion can be drawn, the preliminary data indicated that macrophages and trophoblasts can recruit monocytes.</p>

<p>Syfte och frågeställningar</p><p>Studiens syfte var att undersöka gravida kvinnors aktivitetsvanor under respektive trimester samt barnens födelsevikt. Därför undersöktes moderns fysiska aktivitetsnivå och om den påverkade barnets födelsevikt samt huruvida moderns ålder hade betydelse för vilken form av fysisk aktivitet som utfördes. I studien granskades även om det förelåg någon skillnad beträffande barnets medelfödelsevikt mellan mödrarnas åldersgrupper.</p><p>Frågeställningarna var:</p><p>1. Gravida kvinnors fysiska aktivitetsvanor</p><p>- Antal dagar i veckan</p><p>- Aktiviteter som utfördes</p><p>- Anledning till inaktivitet</p><p>2. Fanns det någon skillnad mellan fysisk aktiva och inaktiva mödrar gällande barnets medelfödelsevikt?</p><p>- Den fysiska aktivitetsnivåns påverkan på barnets födelsevikt.</p><p>3. Skiljde sig valet av fysisk aktivitet och barnets medelfödelsevikt åt mellan mödrarna i respektive åldersgrupp?</p><p>- Förelåg det någon skillnad mellan kvinnornas åldersgrupper gällande om de var fysiskt aktiva eller inaktiva?</p><p>Metod</p><p>Fyra BCV (Barnavårdscentraler) i en storstadskommun kontaktades och totalt delades 116 stycken enkäter ut. Vi fick tillbaka 58 enkäter och analyserade dem i SPSS. Efter insamlandet av enkäten hölls kortare gruppsamtal med sköterskorna på respektive BVC där de fick dela med sig av sina erfarenheter inom området och kring vårt valda ämne. Litteratursökningen som gjordes innebar att vi tittade på tidigare studier för att få en större kunskap inom det valda området. Denna litteratursökning gjordes främst på Internet med hjälp av olika databaser men även utländsk litteratur studerades.</p><p>Resultat</p><p>Resultatet visade att den fysiska aktivitetsnivån hos de gravida kvinnorna sjönk desto senare in i graviditeten de kom. Den form av fysisk aktivitet som kvinnorna valde främst var promenader, men även gruppträning, styrketräning samt annan aktivitet fanns med som dominerande aktiviteter. Främsta anledningen till inaktiviteten som kvinnorna själva angav var medicinska skäl/komplikationer kopplade till graviditeten. För de tre trimestrarna kunde ingen nämnvärd skillnad ses på barnens medelfödelsevikt mellan de kvinnor som varit fysiskt aktiva under graviditeten och de som varit inaktiva enligt vår egen klassificering. Det var främst de yngre mödrarna som stod för denna inaktivitet. Det studien även fann var att de mödrar som födde barnen med en låg födelsevikt, var de kvinnor som under sin graviditet varit mest fysiskt aktiva. Resultaten visade också på att valet av fysisk aktivitet skiljde sig en aning åt mellan de båda åldergrupperna av mödrar och att barnen till de yngre mödrarna hade en obetydligt högre medelfödelsevikt.</p><p>Slutsats</p><p>Vi kan inte från studien dra några generella slutsatser inom ämnet men materialet kan användas för vidare forskning inom området och för att testa olika hypoteser.</p> / <p>Aim and questions</p><p>The aim of this study was to examine pregnant women’s habits in physical activity during the three trimesters and the birth weight of the children. There for the mother’s level of physical activity and if it had any correlation with the birth weight of the child were examined. We furthermore wanted to see if there was a difference between the older and younger women in the choice of activities and in the children’s birth weight.</p><p>The questions were:</p><p>1. Pregnant women’s habits in physical activity</p><p>- The number of days per week</p><p>- The activities that were practised</p><p>- The reasons for inactivity</p><p>2. Was there a difference between physically active and inactive mothers when it comes to the child’s birth weight?</p><p>- The level of physical activities’ influence on the child’s birth weight</p><p>3. Was there a difference in the choice of physical activity and the child’s birth weight between the mothers in respectively age-group?</p><p>- Was there a difference between the women in respectively age-group considering weather or not they were physically active?</p><p>Method</p><p>Four child health centres in a big city municipality were contacted and 116 questionnaires were given out. We received back 58 questionnaires and analyzed them in SPSS. After that shorter interviews were held with the nurses in groups where they shared their experiences in the field. We also looked into other studies made in the field on the Internet and in different databases and literature to get a deeper understanding in the subject.</p><p>Results</p><p>The study showed that the level of physical activity amongst the pregnant women decreased the later in the pregnancy that they proceeded. The study also showed that the pregnant women all in all during the three trimesters foremost practised walks, but weight-lifting, grouptraining and other activities were also performed. The main reason for inactivity was medical reasons/complications connected to the pregnancy. There was no considerable difference in the children’s mean birth weight between the active and inactive mothers according to our definition and it was foremost the younger mothers that were inactive. The study also found that the mothers that gave birth to the children with low birth weight were also the ones that had been most physically active during their pregnancy. The result also showed that there was a small difference in the choice of activities between the two age-groups in the mothers and the children to the younger mothers had an insignificant higher mean birth weight.</p><p>Conclusion</p><p>The results of the study is not enough to make any general conclusions in our subject but it can be used as a foundation for further research in the field and to test different hypothesises.</p>